Individual provider Active NPI

Steven Gale Yuly, MPT

  • Physical Therapist
  • Eagle, ID
National Provider Identifier
1679669436
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT 1607 Issued in ID
Practice address
457 S Fitness PL
Suite 100
Eagle, ID 83616-6568
Phone
(208) 939-3332
Fax
(208) 939-3338
NPI assigned
Oct 5, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT 1607 ID Primary

Addresses

Primary practice location

457 S Fitness PL
Suite 100
Eagle, ID 83616-6568

Mailing address

2311 E Comisky St
Meridian, ID 83642-5301
Phone (208) 939-3332

Other identifiers 3

IdentifierTypeStateIssuer
8071990000MedicaidID
000010142240OtherBLUE SHIELD
TC530OtherBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050623001047 ID Practitioner - Physical Therapist in Private Practice 2961447586 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
RS Physical Therapy PCGroup PAC ID 9931537412, 2 clinicians

Practice addresses (Care Compare)

2204 E Lanark St
Suite 100
Meridian, ID 83642-5916
Phone (208) 908-7907

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT 1607IDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
RS Physical Therapy PC Physical Therapist CurrentSince Feb 20, 2020 Accepting new patients

Locations

457 S Fitness Pl
Ste 100
Eagle, ID 83616
Phone (208) 939-3332

2204 E Lanark St
Ste 100
Meridian, ID 83642
Phone (208) 908-7907

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679669436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2311 E COMISKY ST",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425301",
            "telephone_number": "208-939-3332",
            "fax_number": "208-939-3338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "457 S FITNESS PL",
            "address_2": "SUITE 100",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166568",
            "telephone_number": "208-939-3332",
            "fax_number": "208-939-3338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YULY",
        "first_name": "STEVEN",
        "middle_name": "GALE",
        "name_prefix": "Mr.",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT 1607",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8071990000",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010142240",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "TC530",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.